[Computed tomographic features of cerebral malignant glioma following treatment and regrowth. Tumor response to radiochemotherapy].
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Biomedical subjects
Publications and source records attributed to H Hondo.
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From May 1976, through May 1985, eighty-nine patients with hypertensive cerebellar hemorrhage were admitted to our university hospital and affiliated hospitals. The age at onset ranged from 42 to 86 years, with a mean of 65.1 years. Thirty-one of these patients underwent conservative treatment, 20 were given ventricular drainage, 23 underwent suboccipital craniectomy and 15 underwent stereotaxic aspiration surgery. The patients were classified into four categories according to the grading of hypertensive cerebellar hemorrhage proposed by Matsumoto in 1982. Twenty-two cases were of benign type, 20 were moderate type, 30 were severe type, and 17 were fulminant type. The 22 benign type cases showed good recovery (ADL 1 or ADL 2), whereas the mortality rate of severe type cases was 26.7%, and that of fulminant type cases was 70.6%. The site and extension of hematoma were identified by CT. Fourty cases (45.0%) were confined to the left hemisphere, and 19 (21.3%) were localized in the vermis. When the hematoma volume was more than 15 ml, surgical evacuation of the hematoma was considered. Since 1981, stereotaxic aspiration surgery has been performed in cases of hypertensive cerebellar hemorrhage with a mean patient age of 66.9 years, ranging from 51 to 82 years. Patients treated have consisted of 2 with moderate type hemorrhage, 10 with severe type, and 3 with fulminant type, with an overall surgical mortality rate of 33.3%. However, the outcome of fulminant type hemorrhage has remained ADL 2 or ADL 3. The benefits of this type of surgery are that it is not only indicated as an emergency treatment for patients who are aged or at high risk, but that it can be also performed for fulminant type hemorrhage.
Photoradiation therapy using the photosensitizing agent, hematoporphyrin derivative (HpD), and laser light has been currently employed as a new modality for the treatment of cancer. At present, however, the application of this therapy is limited to superficial tumors because of difficulties in achieving light penetration, whereas 13.56 MHz radiofrequency (RF) used in hyperthermia is capable to penetrate into deeper regions and elevate the temperature of brain tumors. In the present studies, the author evaluated an anti-tumor effect of hyperthermic treatment with HpD administration on experimental malignant brain tumors both in vitro and in vivo and, moreover, investigated the histological changes of subcutaneous tumors following water bath heating and the uptake of HpD into the brain and subcutaneous tumors. In vitro, C-6 and Rous sarcoma virus-induced mouse glioma cells (RSV glioma cells) were incubated in the medium containing HpD (0-125 micrograms/ml) for 24 hours. Hyperthermia was performed either in a water bath or by 13.56 MHz RF heating in the range of 37-43 degrees C. All procedures were carried out in the dark. The anti-tumor effect was evaluated by counting the viable glioma cells. HpD itself showed a growth inhibitory effect on C-6 and RSV glioma cells dose-dependently, while synergistic effect was observed in combination with hyperthermia. C-6 cells were more sensitive to this treatment than RSV glioma cells. The degree of response depended on the heating time and the temperature. In both cells, the effect of heating by water bath and 13.56 MHz RF was similar at each temperature.(ABSTRACT TRUNCATED AT 250 WORDS)
In an attempt to overcome some of the difficulties inherent in vascular anastomosis using standard suture methods, we have developed a technique that allows for rapid non-suture anastomosis of blood vessels. The technique has been used in over 400 anastomoses, including interposition vein grafts in rat, rabbit and dog vessels ranging in size from 0.7 mm to 3 mm in diameter. Animals have been followed for over 1 year postoperatively with serial angiography and histological evaluation including scanning electron microscopy. Stress studies have compared the biomechanical properties of both non-suture and suture anastomosis. The overall patency rate in non-suture end-to-end anastomoses using an interposition vein graft was 85% at 1 year follow up. Histological evaluation revealed a healing pattern that was temporally similar to that of the suture technique. Stress tests revealed no significant difference between suture and non-suture technique. These studies reveal that the non-suture technique compares favourably with the suture technique, and demonstrate the feasibility of applying this technique to man.
CT-guided stereotactic aspiration surgery for the evacuation of hypertensive brain hemorrhage (HBH) has been introduced recently. From December, 1980, to April, 1986, we used aspiration surgery in 375 cases of HBH. The 6-month postoperative outcome of aspiration surgery for acute basal-ganglionic hemorrhage was compared with that after conventional surgery of all Japan and those after conservative treatment. In basal-ganglionic hemorrhage, aspiration surgery led to a favorable clinical experience and outcome, providing the possibility of a new avenue of surgical treatment of HBH.
A case of acoustic neurinoma presenting with subarachnoid hemorrhage is reported. The patient, a 33-year-old female, had suffered from left hearing disturbance and tinnitus for several years prior to admission. She had sudden onset of severe headache in the left posterior auricular region, nausea and vomiting while watching a play-going. Immediately she was brought to a neighboring hospital by ambulance. Lumbar puncture demonstrated xanthochromic cerebrospinal fluid with high opening pressure of 380 mmH2O or more and she was diagnosed as having subarachnoid hemorrhage (SAH). As her level of consciousness was progressively lowered, she was transferred and admitted to our hospital. Findings of plain CT scan on admission suggested that she had a brainstem hemorrhage with acute obstructive hydrocephalus. After the immediate operation of ventricle drainage, she became alert. Two weeks after admission, contrast-enhanced CT scan, internal meatus tomography and vertebral angiography were performed because she complained of tinnitus and hearing loss of her left ear. A huge lt. C-P angle tumor was revealed and its total removal was carried out successfully after V-P shunt operation for her hydrocephalic condition. Histological examination showed a typical acoustic neurinoma. The postoperative course was uneventful only with a moderate facial paresis on her left side. Acute and severe subarachnoid hemorrhage of the posterior fossa in cases of acoustic neurinoma has been reported very sporadically. However, CT examination revealed such a rare case of acoustic neurinoma and lead us to a successful surgical treatment for the patient.
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Computerized tomography (CT) is now available for diagnosis and localization of intracerebral hematoma. Computerized tomography-guided stereotaxic evacuation of hypertensive intracerebral hematoma was performed in 51 cases: 34 basal ganglion hematomas with or without ventricular perforation, 11 subcortical hematomas, three thalamic hematomas, and three cerebellar hematomas. Three-dimensional CT images or biplane CT images were taken to determine the coordinates of the target point, which was the center of the hematoma. A silicone tube (3.5 mm in outer diameter and 2.1 mm in inner diameter) was then inserted into the center of the hematoma through a burr-hole under local anesthesia, and the liquefied or solid portion of the hematoma was aspirated with a syringe. Immediately after the first trial of hematoma aspiration, urokinase (6000 IU/5 ml saline) was administered through this silicone tube and the drain was clipped. Subsequently, aspiration and infusion of urokinase were repeated every 6 or 12 hours until the hematoma was completely evacuated. The silicone tube was removed when repeat CT scanning revealed no residual hematoma. The follow-up results indicate that this procedure is as good as conventional craniotomy and evacuation of hematoma under direct vision. This CT-guided stereotaxic approach for evacuation of the hematoma has the following advantages: 1) the procedure is simple and safe; 2) the operation can be performed under local anesthesia; and 3) the hematoma is completely drained with the aid of urokinase. This procedure seems indicated as an emergency treatment for elderly or high-risk patients who show no signs of cerebral herniation.
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Primary malignant melanoma of the cerebral nervous system is an uncommon entity. A case of primary intracranial melanoma associated with dermoid cyst is reported. The patient was a 40-year-old man who was admitted to our hospital on May 2, 1979 complaining of headache, double vision, left hemiparesis and Jacksonian seizure. On admission he had a slight degree of papilledema. Left abdominal reflex was absent. Lumbar puncture showed high pressure of the cerebrospinal fluid which was otherwise normal. Plain skull films showed a calcification in the pineal region. CT scan demonstrated multiple high density areas with slight enhancement after contrast medium infusion in the right fronto-parietal region and a well defined high density area associated with an irregular low density area without contrast enhancement in the right pulvinar and the atrium and temporal horn of the right lateral ventricle. However, no tumor stain was seen on angiograms. On May 8, 1979 partial removal of the tumor was performed. Areas of black discoloration were seen in the leptomeninges of the right fronto-parietal lobes. Histopathological examination of this tumor revealed primary intracranial melanoma. Postoperatively DTIC, ACNU and Vincristine were administered intravenously but the tumor showed only little sensitivity. He died 5 months after operation. Autopsy was performed on October 8, 1979. Malignant melanoma in the right fronto-parietal lobes was invading the cerebellar hemisphere and spinal cord, but any tumor was not found in any other parts of the body except for this central nervous system. The tumor in the right pulvinar extending to the atrium and temporal horn of the right lateral ventricle was a dermoid cyst with calcification histopathologically. A case of primary intracranial melanoma associated with dermoid cyst has not been reported in any other associated with dermoid cyst has not been reported in any other literature yet.
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We report the radiologic findings of sclerosed hemangioma (SH), a rare variant of hepatic hemangioma. Dynamic contrast-enhanced computed tomography showed a hypodense mass in the liver with delayed enhancement. T2-weighted magnetic resonance imaging showed the mass as hypointense in relation to cerebrospinal fluid. The final diagnosis of SH was made pathologically. Although SH is rare, understanding its radiologic appearance is important to avoid unnecessary surgery and should be included in the differential diagnoses of hepatic lesion with delayed enhancement.
Antiproliferative activity of recombinant murine interferon-beta (Rec-MuIFN-beta) combined with hyperthermia against Rous sarcoma virus-induced mouse malignant glioma (RSV glioma) was investigated both in vitro and in vivo. In vitro, the antiproliferative activity of Rec-MuIFN-beta was enhanced by incubation at elevated temperatures (40 degrees and 43 degrees C). In vivo, combined therapy of Rec-MuIFN-beta treatment and local tumour hyperthermia (43 degrees C) exerted a greater antitumour effect against transplanted RSV glioma in C3H/He mice than either treatment alone, especially when Rec-MuIFN-beta was administered intratumourally. Subsequently, in order to probe the mechanism of enhanced antiproliferative activity, the production of prostaglandin E2 (PGE2) and 2', 5'-oligoadenylate synthetase (2-5A synthetase) in the culture medium of RSV glioma cells was measured. Rec-MuIFN-beta treatment resulted in a significantly greater PGE2 and 2-5A synthetase production at 43 degrees C than at 37 degrees C.